From Antibiosis to HOCl Antisepsis: Far-Forward Infection Control in Modern Warfare.

Abstract

Modern military medicine continues to rely heavily on anti-biotic-based infection treatment, even as antimicrobial resistance, delayed evacuation, and contested logistics erode its effectiveness. A renewed emphasis on antisepsis-safe, stable, potent, broad-spectrum, and field-ready-now offers a practical alternative for far-forward field care and delayed evacuation. Hypochlorous acid (HOCl), a natural antimicrobial compound made by human neutrophils, has regained attention for its effectiveness and safety, making HOCl antisepsis the possible first step in far-forward infection prevention. Advances in electrochemistry now permit local high-volume production of pure, physiologically compatible and noncytotoxic HOCl with a rigorously-tested efficacy and safety profile and a 2-year shelf life. Laboratory, clinical, and humanitarian field data on its application to wounds consistently show rapid microbial reduction and biofilm disruption, leading to measurably enhanced wound healing. For those providing care in resource-limited settings, the use of HOCl demonstrates how infection prevention can move beyond pathogen-specific therapy toward safe and effective antisepsis. This paper outlines the rationale, evidence, and operational considerations supporting a proposed transition. It also argues that adopting point-of-injury wound intervention with HOCl might provide a highly effective, easy to use, and tissue-safe antiseptic for Individual First Aid Kits (IFAKs) and Special Operations medics. It concludes that lessons from the war in Ukraine should inform new research evaluating changes in TCCC protocols.